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Bill

SD 761

An Act ensuring access to fair and reasonable pharmacy networks

194th Legislature (2025-2026) Introduced by Cynthia Creem

Massachusetts bill requiring health insurers to maintain accessible pharmacy networks with transparency standards and appeal processes for excluded pharmacies.

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Bill Summary · SD 761

Legislative bill overview

SD 761 establishes requirements for health insurance plans to maintain "fair and reasonable" pharmacy networks, including minimum standards for pharmacy accessibility and network adequacy. The bill mandates transparency in formulary decisions and creates processes for pharmacies to appeal network exclusions or reimbursement rates.

Why is this important

Pharmacy network restrictions can limit patient access to medications and preferred providers, potentially increasing out-of-pocket costs or forcing patients to travel long distances. This bill addresses concerns that insurers have been narrowing networks to reduce costs while creating gaps in geographic or specialty pharmacy coverage that harm consumer choice and medication adherence.

Potential points of contention

  • Insurer cost concerns: Broader networks and higher reimbursement rates may increase premiums or reduce insurer profitability, which insurers argue gets passed to consumers
  • Definition ambiguity: "Fair and reasonable" lacks precise metrics, potentially creating enforcement challenges and legal disputes over compliance standards
  • Pharmacy economics: Independent and smaller pharmacies support the bill, while some argue it may disadvantage large chains or mail-order pharmacies that operate on different models
  • Appeals process burden: New appeal mechanisms could increase administrative costs and timelines for network decisions

Compiled from official sources — confirm details with the bill’s official record.

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